COVID-19 and Your Safety

  • Our office is open and accepting appointments to provide essential care to patients. Our clinic is in complete compliance with current CDC protocols.
  • We are screening all patients for possible exposure to COVID-19.
  • Special attention and precautions are given to those over age 65 and those with other conditions that may put them at higher risk.
  • Our staff and patients are wearing masks, gloves when appropriate and washing hands frequently.
  • Commonly accessed areas are cleaned and sanitized frequently.
  • Free phone consultations are available to all patients and those individuals who may call in with questions.
  • Please let us know how we may be of service to you.

FAQ About COVID-19

How Mindfulness and Meditation Can Improve Your Health and Well-being

Living Well with Stress and Pain: How Mindfulness and Meditation Can Improve Your Health and Well-being
        When you think of the word “stress,” how does it make you feel? Like many, you may associate stress with negative feelings and emotions like anxiety, worry, fear or frustration. However, these negative feelings and emotions are actually less a reflection of stress itself, and more a reflection of how we perceive stress. In fact, Hans Selye, the world-renowned Endocrinologist and “Father” of stress research, defined stress as “the non-specific response of the body to any demand for change.” In other words, it’s important to realize that stress itself is neither inherently good nor bad. While we tend to recognize its negative effects, there are also other forms of stress that we generally consider to have a positive impact on health and well-being such as exercise, love, laughter, and excitement. As Selye once said, “It’s not stress that kills us, it is our reaction to it.”

     I didn’t understand this concept until fairly recently. When I was in the middle of my doctoral physical therapy program a few years ago, stress had taken on an entirely new meaning for me. I was pushed to my limits with the most external stress I had ever endured before. I was under the obvious pressures of being in graduate school and of becoming a young medical professional, but meanwhile my life outside of school refused to stop. There were also relationship stressors, family stressors, work stressors, and other personal stressors that impacted my daily life. During this time I even developed a cardiac arrhythmia (an abnormal heart beat), which my cardiologist at the time attributed to “high stress and too much caffeine.” Needless to say, after I nearly lost consciousness in the shower once and then again while just sitting in class, this new arrythmia became my wake up call to learn more about stress and how it was negatively affecting my health and well-being.

     As I progressed through my physical therapy program, I also began to learn more about pain, the nervous system, the biopsychosocial model, and patient-centered care. Through my studies and experiences, I began to understand that the mind and body truly cannot be separated. I had always thought this to be true, but didn’t realize how much scientific evidence we actually have to back it up. It became clear to me that the relationship between stress, pain, physical and mental health is incredibly strong, and that each can have quite a direct effect on the other. The other very important concept I learned is that humans are adaptable and resilient to stress and pain, especially when equipped with the right tools to reduce their potentially harmful effects. So today, I want to share with you some of those tools that have helped me and many others to live well with stress and pain.

     When I look back, there are actually several factors that I believe helped me get through graduate school. Family and social support were very important, as was consistent physical activity and a healthy diet. But the real game changer for me was something else. In my final year of PT school I took an elective course taught by Dr. Pauline Lucas, a physical therapist who practices at the Mayo Clinic, where we learned about yoga, meditation and mindfulness and how these can be implemented into our personal and professional lives as healthcare providers. It wasn’t really until I took this course that I realized that stress, just like pain, is both an inevitable and useful part of the human experience. (If you’re confused by this concept and you’re interested in learning more about pain, click on this link to check out my blog on take home tips for understanding and managing pain.) This concept eventually led me to the idea that in order to make the best out of a stressful situation or painful condition, we need to attempt to change our mindsets about stress and pain. And with this, one of my regular mantras came to be the following:

“When you can’t control what’s happening, challenge yourself to control how you respond to what’s happening. That’s where your power is.”  – Unknown

     While this sounds great, I will be honest with you… it takes practice. Luckily, mindfulness and meditation are two evidence-based methods that have shown to significantly help with managing our response to stress and pain, especially when performed consistently. The Greater Good Science Center of Berkeley defines mindfulness as the practice of maintaining “moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment through a gentle, nurturing lens” and without judgement. This is the opposite of where our brains tend to be in default mode, which largely consists of passive mind wandering. Practicing mindfulness allows us to be more present and less distracted, while sharpening our focus and allowing us to be intentional with how we interpret our environment and the stressors in our lives. Using mindfulness as a tool, we can attempt to change our attitudes about stress and pain. This can be done throughout the day by mindfully breathing, walking, exercising, hand-washing, showering, eating, and much more. By being more mindful, we can take control of our thoughts and redirect our attention toward feelings of gratitude, hope and fulfillment instead of being overwhelmed by constant anxiety, negativity, and worry. The next time you wash your hands, follow the prompts in this video, and then check in with yourself to see how you feel afterward.

    Alternatively, meditation is a dedicated practice of focused attention and concentration with the intention to alter the state of consciousness and attain a state of relaxation. This can be done many different ways, but according to Mosby’s Dictionary of Complementary and Alternative Medicine, it typically involves directing one’s attention toward a symbol, sound, thought or breath. Meditation requires patience, non-judgmental attention, and willingness to take time to practice. Perhaps the most common misconception about meditation is that it’s only successful if one’s mind is completely quiet and unbothered by outside thoughts. But, as previously mentioned, it’s actually quite normal to have a wandering mind. Instead, meditation actually involves gently acknowledging any thoughts that may enter your mind, and simply allowing them to pass through just as they entered by redirecting your attention back to the symbol, sound, thought or breath that you chose to focus on during that meditation session. So, when starting a meditation practice it’s important to remind yourself to let go of any expectations, be kind to yourself, and keep practicing because consistency is key.

    The scientifically-validated benefits of practicing meditation are endless. It’s been shown to decrease the perception of stress, improve quality of life, enhance focus, and reduce symptoms associated with depression, anxiety, pain, and insomnia. It’s also been associated with supporting smoking cessation, reducing high blood pressure, reducing inflammation, and reducing menopause symptoms, among many others. If you’re new to meditation, there are plenty of resources available that can be helpful in getting started. Smart device applications like the Calm App, Headspace, and Insight Timer provide guided and non-guided meditations for all levels, and these companies also have social media pages and Youtube channels to follow for helpful tips and mindfulness/meditation practices. If you don’t have a smart device, or if you know that you can’t focus when you have a smart device in front of you, another simple way to meditate is by focusing on your breath. Try to practice breathing in slowly through your nose, and out even slower through your mouth. For some, it may help to count in your head in order to stay focused: inhaling for about 4 seconds, pausing for a brief moment, and then exhaling for approximately 8 seconds. This is what I often recommend for patients who come to see me for various painful conditions, and it’s also what I tend to use myself in times when I’m starting to feel the weight of life’s stressors. Not only does this technique distract you from your stress or pain, but with practice it also helps you regain control of your mental, emotional, and physical responses to stress or pain.

     After reading this, I hope you now understand how practicing mindfulness and meditation can help put stress into perspective by placing you in the driver’s seat when it comes to your own health and well-being. As Viktor Frankl once stated,

“Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

If you’d like to learn more about changing your mindset about stress, psychologist, researcher, and author Kelly McGonigal gave a wonderful TED talk called “How to make stress your friend” that I would highly recommend watching. If you have any specific questions about managing your own stress and pain, our caring and knowledgeable physical therapists at North County Water and Sports Therapy Center may be able to help. Please feel free to give our office a call to inquire about our services and to schedule an appointment.

Tori Williams, PT, DPT

Match Point: Improve your Tennis Game and Reduce Risk of Injury!

Match Point: Staying in the game
Part one in a series

Attention Tennis Players:
Do you want to play at the top of your game and avoid injury?
Tennis requires strength, endurance, power, flexibility, speed, control and balance. In order to play your best, you need practice, technique coaching and a conditioning program so your body can meet the physical requirements of the sport. Your tennis pro is the expert on technique. Your physical therapist is the muscle and movement specialist.

Do you tend to play tennis to stay in condition vs. doing conditioning exercises to play tennis?
Tennis is a sided sport, requiring a conditioning program to avoid muscle imbalance and reduce risk both acute and overuse injury. Most common injury sites in tennis include
• Upper body (shoulder, elbow and wrist) 26-31%,
• Body core (lower back and abdominals) 16-20%
• Lower body (hip, knee and ankle and foot) 39-51% .

Do you wonder what the best exercises are for Tennis?
The physical demands of tennis require aerobic fitness with short bouts of explosive movements, change of direction and sprints. Your style of play, court surface and type of tennis (singles vs. doubles) all have varying training requirements. In general, a well-balanced strength and flexibility program including stability and power drills specific to the sport is recommended.

Do you warm up and cool down after your tennis match?
The warm-up is essential in preventing injury. Warming up helps prepare your muscles, joints and body for the upcoming activity. The cool down is vital in minimizing muscle stiffness, tightness and cramping.

The Warm-Up
The warm-up will prepare your body for the higher intensity levels experienced during the match. The key is to focus on whole body movements taking the joints through the full range of movement and exercises to turn on the muscles in the same way they will be used in playing.

Common warm up exercises*:
Book openers
Body weight squats
Inch worms
Lunge with trunk rotation

Upright arm circles
Side shuffle
Leg swings
Shoulder rotations
Standing W squeeze and reach


For a detailed description and photos of the recommended warm up and cool down exercises call 858-675-1133 and request your free copy!

Cool down:
During the match your body is constantly moving, when it is over the body works to return to normal and gets and instant shock. Because it is no longer under stress there is decreased adrenaline and increased tightness. Cool down essential to avoid cramping, joint stiffness and muscle tightness.
Recommended cool down:
1. Hydrate: drink a sports drink for lost electrolytes. Rule is for every pound of water lost you need to drink 24 oz. of water.
2. Immediately following keep moving, take and easy short walk 10-20 minutes or get on stationary bike without resistance for 10 minutes.
3. After moving stretch major muscle groups * 3 reps each holding each stretch for 30 seconds. Muscles you should stretch include quadriceps, hamstrings, groin, calf, gluts, back, chest and forearm muscles.
4. Within two hours eat a meal with healthy carbohydrates and lean protein.

These exercises are provided as general recommendations and do not replace medical advice. Consult your Physical Therapist before performing a new exercise especially if you are currently injured, experiencing pain, or have a medical condition that may limit your ability to perform these exercises.

For a detailed description and photos of the recommended warm up and cool down exercises call 858-675-1133

To get a specific program designed to meet your needs call 858-675-1133 and ask about our physical therapy movement exam and fitness program development.


Telehealth: A therapist’s perspective

Changing Your Perspective

Change can be a difficult thing for many people, but it is something that is always happening in life. Sometimes we choose the change that happens in our life, sometimes it chooses us. Most people would likely agree that COVID-19 has forced a change for nearly everyone in the world. And with this change, many are trying to take a step back to see the big picture, to figure out what we can learn from all of this. If you have been to our clinic, you know how much we love a good inspirational quote, so here is one from Sun-Tzu: “In the midst of chaos, there is also opportunity.” If you spoke to 100 different people right now and asked them what opportunity they have discovered because of COVID-19, you may get 100 different answers. If you asked a Physical Therapist, you may be surprised to hear that one of their answers is Telehealth Physical Therapy.

Our last blog gave a detailed description of Telehealth Physical Therapy and discussed the benefits associated with this format of healthcare. But now that we have been working with this platform for the past few months, we thought you might find it interesting to hear about how we at North County Water and Sports Therapy Center feel about Telehealth Physical Therapy. So, we asked our therapists three questions, and the results are quite enlightening.

1. What are some things that surprised you about telehealth?
Overwhelmingly, our therapists were (pleasantly) surprised with how easy Telehealth Physical Therapy has been in this time of change and transition. With only a few clicks on a computer, we are able to connect with our patients and begin our interventions.
Additionally, many of our therapists commented on how personal the telehealth visits feel. We are able to see and speak to our patients while they are in their home environment, we can see their individual needs, and we can connect with them one on one uninterrupted to help them progress towards their physical therapy goals.

2. What are some aspects of telehealth that you think can be more beneficial than in-person treatments?

All of our therapists recognize the benefits of seeing the patient perform their exercises in their home, using their own equipment, helping them problem solve how they can use what they have at home to do what they need to do to get the results they want. We can see how people sit or stand at their work station and make real time changes and adjustments in the moment and see immediately results from those changes, a luxury we do not have when we treat patients in the clinic. We can also see how our patients do movements that may cause them problems in their daily life such as lifting, getting in/out of bed, and getting down or up from the floor in their home and can train them in ways to be more efficient or effective in the moment.

We have also noticed how much more engaged the patient is during our telehealth sessions. When we treat a patient in the clinic, there can be a sense of “being treated” by the therapist, the feeling that someone else is making the patient better. It can be easy, especially in an open gym setting, to get caught up in conversation with the therapist or other patients and allow the treatment to become a passive experience, albeit still beneficial. With telehealth, the patient must do for themselves the things the therapist always used to do for them. This creates not only a greater accountability on the part of the patient, but also a sense of empowerment as the patient is now taking control of their condition and given the resources to help themselves feel better and meet their goals.

3. What have you learned in your experiences with telehealth that will now change or shape how you treat patients in person?

Here it is… the opportunity! As physical therapists, we regularly attend courses to learn how to better serve and help our patients, learning how to use different tools or different techniques to help our patients meet their goals and improve their overall function and quality of life. Incorporating telehealth physical therapy into our practice has been just as enlightening as a continuing education course.

All of our therapists agree that we will now be more aware of how we educate and give feedback and verbal cues to our patients, being more descriptive with words when teaching or correcting movement rather than only relying on our hands to correct movement. Education is a large part of what we do as physical therapists. Telehealth physical therapy has taught us that educating our patients and empowering them with knowledge and accountability, rather than relying on our hands, is imperative to the long term success of our patients.

We have also learned that telehealth is not only for pandemics when patients cannot leave their home. For the patient who is receiving in-person treatments in the clinic, a few telehealth treatments to allow the therapist to see their home exercise set up, sleep positions, or home workstation can make a huge impact in the patient’s ability to manage their own condition for the long term beyond completion of in-person treatments.

We at North County Water and Sports Therapy Center are focusing on the opportunity, not the chaos. Telehealth physical therapy is continuing to be a beneficial platform for our patients. If you have questions or are interested in getting started with telehealth physical therapy, please contact our office and we would be happy to discuss your options.

To see more check out

Therapist during telehealth session
Interacting with clients through telehealth!

Connect and Thrive with Telehealth Physical Therapy

Connect and Thrive with Telehealth Physical Therapy
How many times have you used technology in the past month to communicate with loved ones, co-workers or others in the outside world? Now, take yourself back in time 20-30 years and your answer to this question would likely have been very different. In this day and age, it goes without saying that technology has changed the way we communicate, collaborate, and connect with others. The medical field is no exception to this, and new methods of providing healthcare have begun to emerge in recent years. In the past, you may have used an online portal to check in with your medical provider or to obtain health information such as testing or imaging results. But what you may not know, or may not have known before COVID-19, is that you can also spend face-to-face time with your healthcare provider via virtual or online platforms. Telehealth, or telemedicine, is a term that broadly refers to the ability to communicate with and/or obtain healthcare services directly from your medical providers through telephone, video call, or other online platforms.

What is Telehealth Physical Therapy?
Connect with simple to use, real time video conferencing technology, and work with your musculoskeletal problem solver (aka your physical therapist) to develop and implement a movement and treatment plan specific to your goals.
For the purposes of this blog, we will be referring to “telehealth” as the method in which you engage in a virtual visit with your physical therapist through a video call from the safety and comfort of your own home. Telehealth physical therapy at our clinic includes one-on-one remote evaluation, consultation, education, and treatment of individuals with various musculoskeletal conditions. This occurs through a private video call, with a link sent to your e-mail which you can access from your phone, tablet, laptop, or computer. During these visits, your therapist will spend time asking you about your problem, assessing your movements, and creating an individualized care plan to manage your symptoms and improve your daily function – just like they would here in the clinic. Telehealth also gives your therapist an opportunity to virtually assess your home environment and address any challenges you may be having at home such as optimizing your home office or desk set up, navigating certain steps or stairs, or figuring out exactly where and how to perform your prescribed home exercises.

What are the benefits of Telehealth Physical Therapy?
Effective treatment to get you back to doing the things in life you want and need to do. The best part is that is convenient, saves time, saves money all from the safety and comfort of your own home.

Telehealth physical therapy services have been gaining popularity over the past several years, largely because it is convenient, private, safe, and cost-effective. Telehealth is ideal for those who would like to save time, money and energy spent on travel. It also provides access to care for those who are unable to come into the clinic due to transportation challenges or because they live in rural or distant areas. During this time in particular, telehealth physical therapy offers a safer option for receiving care that allows patients to stay at home while physically and socially distancing during the coronavirus pandemic. Another benefit is that telehealth physical therapy is also available via direct access, meaning you don’t have to have a referral from your doctor to get started.
New research has demonstrated reduced costs, improved patient outcomes, increased access to healthcare services, and higher patient satisfaction with the use of telehealth physical therapy. Here is a testimonial from one of our patients who has opted for telehealth physical therapy services at our facility:
“Working with skilled physical therapists using telehealth is just like being in person… without the commute! I’ve increased my physical therapy sessions to compensate for regular chiropractic, which cannot be conducted remotely, and it’s working great! Keeping up with physical therapy during this time is extremely important and very helpful for overall wellbeing. Given the recent changes in telehealth rules, all Californians now have access to the most competent physical therapists in our state and possibly our country, not just those who live in San Diego! Take advantage of it!” –Stacy

Physical Therapist talking with a patient

How do I know if Telehealth Physical Therapy is right for me?
re you wondering if telehealth would be right for your particular situation? To help decide consider the following questions:
1. Do I have access to internet and a smart device with a camera? Telehealth physical therapy visits can be accessed from any smart phone, tablet, laptop or computer that has a camera, as long as the device can be set up in a way that allows your physical therapist to see your full body during the visit.
2. Do I feel comfortable exercising in my home? It is helpful during telehealth sessions to have a little bit of space in your home where you can perform exercises and move around. Some situations may also require a caregiver or helper to be present during telehealth sessions to assist with certain activities and make sure you are safe.
3. Do I need hands-on treatment? Many patients benefit most from a physical therapist’s expertise through guided exercise, functional movement training, self-massage techniques and education regarding pain or symptom management strategies which can be done safely and independently in your own home. However, in some cases your physical therapist may recommend that you attend visits in the clinic in order to evaluate or treat you with hands-on methods.
Ready to sign up for telehealth? Call us at (858) 675-1133 or click the following link to fill out the intake form and we will get back to you right away: click to fill out basic information form

Still have more questions? Give us a call and our staff will guide you in finding the best option to get you moving again and back to doing the things you love.


Are you a New Year’s Resolution Newbie, Master or Flunkee?

Are You a New Year’s Resolution Newbie, Master or Flunkee?

Turning the page on the new year is a chance to wipe the slate clean—and to be better versions of ourselves. And when it comes to what we want to improve, goals that fall in the health and wellness arena top all other New Year’s resolutions. In fact, three of the top four resolutions in a 2018 YouGov poll were health-related: eat healthier (1), get more exercise (2) and focus on self-care, e.g., get more sleep (4). There are three types of people who choose a goal from the health and wellness category as a New Year’s resolution: the resolution newbie, the resolution master and the resolution flunkee. Let’s see which category you most identify with—and how focusing on the right strategy can help you get healthier in the new year.

Resolution Newbie. Maybe this is your first time making a commitment to your health and wellness. Good for you! Did a recent event like a health scare or loss of a loved one make you see the light? Or perhaps you want to be more active to enjoy activities with your grandchildren or to carry your own bag on the golf course. Whatever your goals are, taking that first step is a big one so you’ll want to be sure that you’re prepared for the challenge. Particularly when exercising for the first time or returning to an active lifestyle after a long hiatus, it’s important to have the proper information and tools to be successful. And that means tapping the healthcare resources available to you: Clinicians like nutritionists and physical therapists can make sure that your body is prepared to take on new challenges and work with you to a design a program that will help you achieve your goals.

Resolution Master. Perhaps you fall into a different camp: You vowed to get healthy in 2019 and you achieved it! For 2020, your resolution is to continue the work you’ve begun. After all, living a healthy lifestyle is a lifelong commitment; it’s not something you do for a while and then revert back to your former habits. As you prepare to embrace the new year, are there any small tweaks you can make to advance your goals? Maybe you’re thinking about training for and running a half marathon, but don’t know where to begin. A physical therapy evaluation is a great place to start—PTs are trained to assess your movement patterns and identify any limitations or weaknesses. Based on that information, the PT can design a personalized exercise program to help you safely and effectively prepare for the grueling half marathon course.

Resolution Flunkee. Let’s say your plan for 2020 is to get in better shape and improve your overall health (we support that resolution!), but this isn’t your first rodeo. Your 2019 resolution was pretty similar but it’s one year later, and you’re in the same place you were on New Year’s Eve 2018. What stood in your way—was it time? Affordable options? Access to healthy choices and activities? If any of these barriers sound familiar, then along with your resolution, you need an action plan. Without planning ahead, you’ll find yourself staring down the year 2021 with the same goal in mind. But let’s not focus only on the negative—what went right last year? Maybe you made sleep a priority, which in turn helped you to make better food choices at breakfast but by afternoon, you found yourself choosing to energize with a soda and candy bar when all you probably needed was an apple and a 15-minute walk. Take some time to think about the previous year—good and bad—and take with you what you need, and leave the rest behind. Afterall, you can’t plan where you’re going without understanding where you’ve been.

Which resolution type are you?

Do You Know Your Movement Vital Signs?

Do You Know Your Movement Vital Signs?
Most people think of heart rate or blood pressure when they think of vital signs. It is common to use numbers to quantify health and risk of disease. The American Heart Association encourages people to “know their numbers” referring to blood pressure, blood cholesterol, blood glucose, and weight. However, research is now showing the importance of moving properly for health. Let’s take a look at some of the numbers you can use to quantify your movement health:

Walking Speed
Walking speed has been called the “sixth vital sign” in medical literature recently. It is easy to measure, and takes into account strength, balance, coordination, confidence, cardiovascular fitness, tolerance to activity, and a whole host of other factors. It has also been shown to be predictive of future hospitalizations, functional decline, and overall mortality. Normal walking speed is considered to be 1.2 to 1.4 meters per second.

Push Ups
Push ups are popular to build strength, but a recent study found that they can show us a lot about your heart too. Researchers found that men who could do 40 or more consecutive push ups were at a 96% lower risk for cardiovascular disease than were men who could do less than 10. The push up test was also more useful in predicting future cardiovascular disease than aerobic capacity measured on a treadmill.

Grip Strength
Hand grip strength has been shown to be strongly correlated with health. The stronger your hand grip is, the less likely you are to suffer from cardiovascular disease, respiratory disease, COPD, and all types of cancer. In the study, muscle weakness was defined as grip strength <26 kg for men and <16 kg for women. Grip strength below these numbers was highly correlated with an increase in disease.

Standing From the Floor
If you can’t easily get down on the floor and back up your health might be in trouble, according to a study that looked at more than 2,000 people. The study asked people to go from standing to sitting on the floor and back up with as little support as needed. They found that if you need to use more than one hand to get up and down from the floor that you were 2 to 5 times more likely to die in the next 7 years than someone who can do it with just one hand, or even better, no hands at all.

Moving well is obviously important to overall health and longer life. These tests can give a snapshot of how you’re doing. If you’re having trouble with any of them, considering seeing a movement specialist – your physical therapist.

Take Home Tips for Understanding and Managing Your Pain

Hurt Does Not Equal Harm: Take-Home Tips for Understanding and Managing Your Pain

Pain is a common experience shared by all human beings. It’s the body’s natural alarm system which is produced by the brain and occurs in response to a perceived threat. This means that pain is not only normal, but necessary for survival. However, as most of us know, suffering from pain has the potential to be very disruptive to daily life. But what many don’t realize is that pain, especially pain that persists for long periods of time, is extremely complex. Factors that impact pain include physiological stress (i.e. muscles, bones, ligaments, and nerves), emotional and psychological stress, sleep hygiene (i.e. amount of sleep, quality of sleep, and regularity of sleep pattern), past experiences with injuries or pain, and beliefs about pain and recovery. For this reason and many others, everyone experiences pain differently and will have different ways to manage pain for different situations.
As you may have heard in the media, the U.S. is currently in an opioid epidemic as a result of increased prescription and abuse of pain medications. This is because opioids have been found to be highly addictive which can lead to overdose and death if used improperly. Luckily, there are many ways in which pain can be managed without using pain medication. Your physical therapist can help you better understand and manage your pain. Here is a testimonial from a previous patient about her experience with managing her painful condition at our facility:

“Over the past 20 years, I have suffered with painful lower back pain, sciatica and shoulder issues. I have sought treatment from countless physical therapists and orthopedic surgeons. Along with the enduring physical pain, I developed a fear to pursue activities that I enjoyed; I was worried that exercise could worsen my condition. At the evaluation appointment, I expressed fear, hopelessness and skepticism about undergoing more physical therapy treatment. However, soon it became clear to me that this experience would be different because Tori was different than what I’ve ever experienced. She was patient, encouraging and pushed me beyond what I thought I could accomplish. I’ve never been treated and taken care of with so much one on one care. I’ve never been consistent or motivated with PT exercises, however, this time I was. I benefitted from being educated on correct lifting techniques and form applied to my weight training at the gym, backyard gardening, lap swimming, daily living activities, and even mastering stairways! I am for the first time in many years finally not fearful of pursuing my preferred active lifestyle.”

– Emma

You, too, are capable of taking back control of your life with pain management strategies individualized to you. Below are some take-home tips to help you get started.
1. Understand that pain does not always equal harm or tissue damage. As previously mentioned, pain is complicated. And in many cases, it isn’t a direct reflection of the health of our body’s tissues or structures. Your physical therapist can help you identify various factors that may be contributing to your pain experience and can help guide you through movements that will help you get back to your daily life. If you’re feeling stuck or are interested in learning more about your pain, your physical therapist may introduce you to the “Why Do I Hurt? Workbook,” an interactive and evidence-based booklet created by Dr. Adriaan Louw, PT, PhD, that can further help you understand and lessen your pain. The following quote is from a previous patient who utilized the workbook:

“Dr. Tori Williams helped me work on a painful hip problem that had been preventing me from exercising and interfered with sleeping well. The physical therapy did the trick, however at one point I felt like progress had stalled and I was frustrated. I was getting stronger and could move much better, but the pain kept flaring up. Tori suggested that the Why Do I Hurt Workbook might give me some insight on the problem. The Workbook provided the missing pieces of the puzzle. It helped me put it all together and move past the pain cycle. I learned that the tissue problem is only one part of the equation. My history, emotions and attitudes were me keeping me in the pain cycle. Once I began to work on some of those things, combined with the PT and exercise I was able to easily move forward and move out of the pain cycle”

– Pat

Another patient who has used the workbook had this to say about what he learned:

“It helped me understand how personal emotions and the fear of pain can cause pain. Now I realize how physical activity can help mitigate the pain and strengthen me both physically and mentally. I don’t focus on the pain when I am physically active and the book taught me the importance of that.”
– Steve

2. Find your favorite relaxation techniques. As previously mentioned, pain occurs in response to a perceived threat. This can come in many forms and can be compounded by physical, emotional, and mental stress. Relaxation techniques such as deep breathing, meditation, listening to music, and soft tissue massage can be helpful in managing stress and turning down the body’s natural alarm system. Taking as little as 5 minutes of each day to devote to relaxation can be beneficial to decrease pain and stress over time. One evidence-based strategy for calming your nervous system is using the 4-7-8 breathing technique which involves breathing in through the nose for 4 seconds, holding for 7 seconds, and exhaling through the mouth slowly for 8 seconds.

3. Keep moving. Research has shown that just a single bout of light aerobic exercise increases the production of the natural opioids produced by your body, called endogenous opioids. These are well-known to reduce anxiety, enhance mood, and aid in pain relief. So if you are able to move around, it’s always a good idea to work up a little sweat by going for a walk, jog, bike ride, or participating in other physical activities that you enjoy. If you’re concerned that movement might make your condition worse, your physical therapist can provide reassurance and help you determine which exercises and at what intensity and duration are appropriate and individualized to you. Movement is medicine!

4. Establish healthy sleep habits. Sleep is crucial for daily functioning and has been shown to have effects on how your body processes and perceives pain. This means that if you don’t get adequate sleep, you may experience increased pain, reduced quality of life, and a whole host of other negative effects. Try going to bed and waking up at the same time every day to help set your body’s natural biological clock. You should also try to block blue light before bed, which has been shown to disrupt the ability to fall asleep and stay asleep. This includes the light from your cell phone, television, or tablet. (Tip: Most smart devices now have blue light screens/off switches which can be manually or automatically turned on at night.) Lastly, make your bed a sacred sleeping place; try not to do anything in your bed other than sleep and sexual activities.
If you are struggling with pain, know that you are not alone and there is hope. Our qualified physical therapists at North County Water and Sports Therapy Center can help you establish an individualized plan to manage your pain.

Tori Williams, PT, DPT

1. Louw, A. Why Do I Hurt? Workbook. Orthopedic Physical Therapy Products; 2016.
2. Goyal M, Singh S, Sibinga E, et al. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. Deutsche Zeitschrift für Akupunktur. 2014;57(3):26-27. doi:10.1016/j.dza.2014.07.007.
3. Hannibal KE, Bishop MD. Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy. 2014;94(12):1816-1825. doi:10.2522/ptj.20130597.
4. Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Practice & Research Clinical Rheumatology. 2015;29(1):120-130. doi:10.1016/j.berh.2015.04.022.
5. Siengsukon CF, Al-Dughmi M, Stevens S. Sleep Health Promotion: Practical Information for Physical Therapists. Physical Therapy. 2017;97(8):826-836. doi:10.1093/ptj/pzx057.
6. Louw A, Puentedura EJ, Zimney K, Schmidt S. Know Pain, Know Gain? A Perspective on Pain Neuroscience Education in Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy. 2016;46(3):131-134. doi:10.2519/jospt.2016.0602.

Can I return to Golf after joint replacement surgery?

Can I return to golf after a total joint replacement?

The main reasons individuals chose to undergo a total joint replacement surgery (either shoulder, hip or knee) is to reduce pain and get back to doing the things they love. For 26 million Americans, golf is the sport they love to do. Many questions arise when golfers who happen to be our patients have a joint replacement surgery.

Two of the most common questions are:
Can I return to golf?
How soon can I return to golf?

The answer depends greatly on type of surgery, the surgeon and compliance with rehabilitation.

Looking at the research many golfers who had a total joint replacement return to golf. The average time to return to golf depends on which joint was replaced and the activity level prior to surgery. The average time frame ranges from 4 to 8 months.

Unique rehabilitation challenges present themselves depending on the joint involved.

For total shoulder and reverse total shoulder replacement good range of motion and strength are essential. This takes time, communication with the surgeon and especially patient and therapist working as a team to safely and effectively progress through basic rehabilitation to a golf specific exercise routine.

There are different surgical approaches to hip replacement. The approach will dictate any precautions after the surgery. Once basic healing and strength are achieved, gaining rotational control components at the hip and pelvis are necessary for return to golf.

With knee replacement surgery, initial rehabilitation focuses on range of motion. Returning to golf after getting a new knee, lies in gaining stability at the knee and of course strength and mobility of the hips, trunk and shoulders.

So the answer is YES you can return to golf. The better shape you are in before the surgery the more likely you are to return to golf. After the surgery, you will need to be patient and allow the body to heal. Exercise is necessary as you recover to regain your endurance. Golf requires you to use your whole body. Meaning while you are protecting the joint that was replaced you can be doing golf specific exercise at other joints to keep and tune up the rest of the body. Making it easier to return once the involved joint is ready to go.

How many steps to you think the average golfer takes when walking the course? 11, 000 steps! For that reason, when you do return we recommend using the golf cart for the first year after surgery reducing undue stress. Even if you had a shoulder replacement a cart prevents you from having to carry your clubs.

We can’t guarantee you will play better after surgery but as physical therapists and movement experts we can get you moving better and back in the game.

Planes Trains and Automobiles: Healthy Travel Part Four

Part four- Preventing traveler’s thrombosis


Traveler’s thrombosis is known in medical terms as a deep vein thrombosis (DVT). A DVT is a blood clot restricting circulation usually in the lower extremity. The problem with a DVT is if the blood clot dislodges and travels from the leg to the heart, brain or lungs. It can lead to heart attack, stroke or when it goes to the lungs, it is known as a pulmonary embolism (PE) and restricts breathing. All of these are serious, life threatening conditions.


Risk factors for developing a DVT include:

  1. Dehydration
  2. Age with the risk increasing after 40 years old
  3. Obesity (body mass index: BMI greater than 30kg/m2)
  4. Previous DVT (the CDC states that one third of individuals with DVT/ PE will have a reoccurrence within 10 years)
  5. Family history of blood clots
  6. Varicose veins
  7. Recent surgery or injury (within the last three months)
  8. Pregnancy
  9. Oral contraception
  10. Hormone replacement therapy
  11. Cardio-respiratory disease
  12. Active cancer or recent cancer treatment
  13. Other chronic illness

**anyone with three or more of these risk factors should consult their doctor about preventative measures prior to long haul flight of 4hours or greater


Recognize the symptoms

Immediate treatment is always preferred. However, about half of the people with a DVT have no symptoms at all. The most common symptoms include

  1. Swelling in the leg or arm
  2. Pain and tenderness, you cannot explain
  3. Skin warm to the touch
  4. Redness to the skin

**If you have these symptoms contact your doctor as soon as possible.


The following are signs of a pulmonary embolism. If you have any of these symptoms seek immediate medical attention.

  1. Shortness of breath (difficulty breathing)
  2. Faster than normal or irregular heartbeat
  3. Chest pain or discomfort that often worsens with deep breathing or coughing
  4. Coughing up blood
  5. Anxiety, light headiness, or fainting


Preventive measures

Prevention is always preferred. The following are steps you can take to decrease the risk of DVT.

  1. Regular stretching and mobility exercise and when possible walk around the cabin during flight.
  2. Stay hydrated (drink plenty of non-alcoholic beverages) The rule of thumb is drink enough fluids to keep your urine pale in color.
  3. Taking a low dose aspirin tablet (75mg) for its anti-adhesive effects on blood platelets. Be sure to talk to your doctor before adding aspirin with any other medications.
  4. Use graded compression stockings
  5. Wear loose fitting clothing and avoid crossing your legs to reduce compression on the veins.


For online video link and handout of Exercises You Can Do in your seat: call our office 858-675-1133 and ask for your airplane, seated exercises to be e-mailed directly to you.



References for DVT information:

Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2011 Apr;6(2):113-6.

Planes Trains and Automobiles: Travel Healthy: part three

Part three- Seat Adjustments:


Bring your seatback and tray table into their upright and locked position.

Not that you would notice it was back.


If you have been on an airplane in the last few years you probably have noticed that airplane seats are not completely designed for the human body. When originally designing airplane seats the engineers incorrectly measured average hip width to determine seat width. Many of the world’s population the widest part of the body is the shoulder width. No wonder you literally are rubbing shoulders with your neighbor. This, along with seats becoming narrower and closer together means we are bound to a small space for the duration of the flight. Even the upfront, expensive seats, although provide more wiggle room do not fit all body types. So, if you do not fit, how do you keep the desired posture and alignment your physical therapist has recommended?


  1. Use the pillow (when provided), folded pashmina, blanket or jacket you brought on board behind your back. If you feel your lower back is rounded place lower down to provide lumbar support. If you feel the headrest is pushing your head forward place he roll between your shoulder blades to allow your ears to now align over your shoulders.
  2. If you are too short for your feet to touch the ground when all the way back in the seat you may want to invest in a folding foot rest or after takeoff use your carryon luggage to prevent dangling and excessive pressure on the back of the thighs reducing circulation.
  3. If you are too tall. You are too tall! The best course of action is to plan and book an aisle, bulkhead or exit row seat. Difficult for the casual travel with airlines charging more for those seats. Depending on the length of the flight and your size it might be worth a few extra dollars.
  4. If you have a lower extremity injury not only the aisle or bulkhead seat is desired but think about which side keeps the involved limb towards the aisle so when the heavy carts are not coming your way you can stretch out into that space. Keep in mind people boarding a plane do not pay attention so protect the leg by keeping it clear until people are on board.
  5. If you have an upper extremity injury sensitive to jarring especially after shoulder surgery, dislocations and fractures, attempt to get a window seat with the involved side next to the window to minimize bumps form others. Bring a pillow or jacket to support and cushion the arm.
  6. Get up frequently when possible. Perform a few exercises and stretches in your seat. See recommendations under next section: preventing traveler’s thrombosis.